Provider First Line Business Practice Location Address: 
PEDIATRIC EDUCATION OFC
    Provider Second Line Business Practice Location Address: 
CAMPUS BOX 7593
    Provider Business Practice Location Address City Name: 
CHAPEL HILL
    Provider Business Practice Location Address State Name: 
NC
    Provider Business Practice Location Address Postal Code: 
27599-7593
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
919-966-3172
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/02/2016