Provider First Line Business Practice Location Address: 
101 MANNING DRIVE, 2000 OLD CLINIC
    Provider Second Line Business Practice Location Address: 
CB 7510
    Provider Business Practice Location Address City Name: 
CHAPEL HILL
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27599
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
919-966-4400
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/26/2014