Provider First Line Business Practice Location Address:
400 SPARTAN DR.
Provider Second Line Business Practice Location Address:
SALEM HIGH SCHOOL
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-387-2437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2013