Provider First Line Business Practice Location Address:
390 SALEM AVENUE
Provider Second Line Business Practice Location Address:
DBA SALEM FAMILY PRACTICE AT GATEWAY
Provider Business Practice Location Address City Name:
WINSTON-SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-721-2375
Provider Business Practice Location Address Fax Number:
336-721-2394
Provider Enumeration Date:
02/27/2008