Provider First Line Business Practice Location Address:
1903 S HAWTHORNE RD
Provider Second Line Business Practice Location Address:
DBA EDWIN H. MAETINAT REHABILITATION CENTER
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-718-6700
Provider Business Practice Location Address Fax Number:
336-718-6790
Provider Enumeration Date:
09/01/2006