Provider First Line Business Practice Location Address:
1606 PHYSICIANS DRIVE
Provider Second Line Business Practice Location Address:
INSIDE PROMINA HEALTH
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-859-4678
Provider Business Practice Location Address Fax Number:
877-688-3638
Provider Enumeration Date:
11/16/2018