Provider First Line Business Practice Location Address:
6719 GOV.G.C.PERRY HWY
Provider Second Line Business Practice Location Address:
CLINCH VALLEY MEDICAL PLAZA SUITE 1600
Provider Business Practice Location Address City Name:
RICHLANDS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24641-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-596-9510
Provider Business Practice Location Address Fax Number:
276-596-9512
Provider Enumeration Date:
11/03/2005