Provider First Line Business Practice Location Address: 
1 MEDICAL CENTER BOULEVARD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WINSTON SALEM
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27157-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
336-713-4500
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/05/2020