Provider First Line Business Practice Location Address: 
100 EMANCIPATION DR
    Provider Second Line Business Practice Location Address: 
OCCUPATIONAL THERAPY DEPT.
    Provider Business Practice Location Address City Name: 
HAMPTON
    Provider Business Practice Location Address State Name: 
VA
    Provider Business Practice Location Address Postal Code: 
23667-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
757-229-6671
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/19/2006