Provider First Line Business Practice Location Address:
1200 NORTH ELM STREET
Provider Second Line Business Practice Location Address:
MOSES CONE HOSPITAL - ROOM #2C306
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-832-8103
Provider Business Practice Location Address Fax Number:
336-832-2214
Provider Enumeration Date:
08/22/2018