Provider First Line Business Practice Location Address:
HINES MENTAL HEALTH HOME NO. 2
Provider Second Line Business Practice Location Address:
105 MIDIAN COURT
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27105-5966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-986-2495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007