Provider First Line Business Practice Location Address:
ECU SCHOOL OF DENTAL MEDICINE, LAKESIDE ANNEX #7
Provider Second Line Business Practice Location Address:
MAIL STOP 701
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-4354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-737-7040
Provider Business Practice Location Address Fax Number:
252-737-7049
Provider Enumeration Date:
07/27/2006