Provider First Line Business Practice Location Address: 
4550 NEW LINDEN HILL RD
    Provider Second Line Business Practice Location Address: 
RED CLAY CONSOLIDATED SCHOOL DISTRICT
    Provider Business Practice Location Address City Name: 
WILMINGTON
    Provider Business Practice Location Address State Name: 
DE
    Provider Business Practice Location Address Postal Code: 
19808-2930
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
302-552-3797
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/05/2009