Provider First Line Business Practice Location Address: 
780 LYNNHAVEN PKWY
    Provider Second Line Business Practice Location Address: 
SUITE 400 ATLANTIC PSYCHIATRIC SERVICES
    Provider Business Practice Location Address City Name: 
VIRGINIA BEACH
    Provider Business Practice Location Address State Name: 
VA
    Provider Business Practice Location Address Postal Code: 
23452-7332
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
757-468-0550
    Provider Business Practice Location Address Fax Number: 
757-468-9992
    Provider Enumeration Date: 
04/06/2006