Provider First Line Business Practice Location Address:
UVA NORTHRIDGE
Provider Second Line Business Practice Location Address:
2955 IVY ROAD
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-243-4646
Provider Business Practice Location Address Fax Number:
434-972-4260
Provider Enumeration Date:
02/22/2007