Provider First Line Business Practice Location Address:
1500 E.WOODROW WILSON
Provider Second Line Business Practice Location Address:
G.V. (SONNY) MONTGOMERY, VAMC; NURSING SERVICE (118)
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-362-4471
Provider Business Practice Location Address Fax Number:
601-368-3917
Provider Enumeration Date:
07/28/2006