Provider First Line Business Practice Location Address:
WAKE FOREST UNIVERSITY, MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
PSYCHIATRY AND BEHAVIORAL MEDICINE
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
27157-1087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-242-0483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2012