Provider First Line Business Practice Location Address:
ONE MEDICAL CENTER BLVD - 10 ARDMORE TOWER WESR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-713-2238
Provider Business Practice Location Address Fax Number:
336-713-2242
Provider Enumeration Date:
11/02/2005