Provider First Line Business Practice Location Address: 
1000 PARK FORTY PLZ
    Provider Second Line Business Practice Location Address: 
SUITE 280
    Provider Business Practice Location Address City Name: 
DURHAM
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27713-5249
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
919-768-4642
    Provider Business Practice Location Address Fax Number: 
919-382-5172
    Provider Enumeration Date: 
01/25/2006