Provider First Line Business Practice Location Address:
321 B POPLAR DRIVE
Provider Second Line Business Practice Location Address:
SUITE 4 CHILDREN'S HOSPITAL THERAPY CENTER
Provider Business Practice Location Address City Name:
PETERSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-321-7474
Provider Business Practice Location Address Fax Number:
804-228-5210
Provider Enumeration Date:
07/22/2008