Provider First Line Business Practice Location Address:
501 W. 14TH STREET
Provider Second Line Business Practice Location Address:
WILMINGTON HOSPITAL, 2ND FLOOR
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-428-4411
Provider Business Practice Location Address Fax Number:
302-428-4078
Provider Enumeration Date:
05/15/2006