Provider First Line Business Practice Location Address:
2520 INDEPENDENCE BLVD
Provider Second Line Business Practice Location Address:
WILMINGTON AMBULATORY PRACTICE
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-243-3839
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2013