Provider First Line Business Practice Location Address:
1007 E HIGH STREET
Provider Second Line Business Practice Location Address:
CENTER FOR WELLNESS AND CHANGE, LLC
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-202-8612
Provider Business Practice Location Address Fax Number:
434-321-5181
Provider Enumeration Date:
10/05/2006