Provider First Line Business Practice Location Address:
047 BAKER HOUSE, TRENT DRIVE
Provider Second Line Business Practice Location Address:
DUMC 3624
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-684-5301
Provider Business Practice Location Address Fax Number:
919-684-6674
Provider Enumeration Date:
01/22/2007