Provider First Line Business Practice Location Address:
250 CHARLOIS BLVD
Provider Second Line Business Practice Location Address:
DBA WINSTON-SALEM HEALTHCARE (CAPITATED PLAN)
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-718-1000
Provider Business Practice Location Address Fax Number:
336-718-1298
Provider Enumeration Date:
08/07/2007