Provider First Line Business Practice Location Address:
WAKE FOREST SCHOOL OF MEDICINE
Provider Second Line Business Practice Location Address:
DEPT OF PEDIATRICS, MEDICAL CENTER BLVD
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157-1081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-4663
Provider Business Practice Location Address Fax Number:
336-716-2525
Provider Enumeration Date:
07/21/2010