Provider First Line Business Practice Location Address:
SOUTHEASTERN VIRGINIA HEALTH SYSTEMS-48TH STREET PHYSIC
Provider Second Line Business Practice Location Address:
4714 MARSHALL AVE
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-380-8709
Provider Business Practice Location Address Fax Number:
757-952-1345
Provider Enumeration Date:
02/19/2007