Provider First Line Business Practice Location Address:
DUMC 3022
Provider Second Line Business Practice Location Address:
WALLACE CLINIC
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-660-6746
Provider Business Practice Location Address Fax Number:
919-681-4849
Provider Enumeration Date:
06/22/2005