Provider First Line Business Practice Location Address:
DEPARTMENT OF DENTISTRY, WFUSM
Provider Second Line Business Practice Location Address:
MEDICAL CENTER BOULEVARD
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157-1093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-2164
Provider Business Practice Location Address Fax Number:
336-716-9045
Provider Enumeration Date:
06/16/2005