Provider First Line Business Practice Location Address:
3300 ACADEMY AVE
Provider Second Line Business Practice Location Address:
ACADEMY CROSSING MEDICAL PLAZA
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23703-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-483-6404
Provider Business Practice Location Address Fax Number:
757-483-0737
Provider Enumeration Date:
09/15/2005