Provider First Line Business Practice Location Address: 
701 GROVE RD
    Provider Second Line Business Practice Location Address: 
GREENVILLE HOSPITAL SYSTEM, NEONATOLOGY DEPT.
    Provider Business Practice Location Address City Name: 
GREENVILLE
    Provider Business Practice Location Address State Name: 
SC
    Provider Business Practice Location Address Postal Code: 
29605-5611
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
864-455-7939
    Provider Business Practice Location Address Fax Number: 
864-455-3685
    Provider Enumeration Date: 
04/17/2006