Provider First Line Business Practice Location Address:
285P HWY 49
Provider Second Line Business Practice Location Address:
LUNENBERG CORRECTIONAL CENTER MEDICAL DEPT
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23974-0650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-696-2045
Provider Business Practice Location Address Fax Number:
434-696-2299
Provider Enumeration Date:
01/19/2007