Provider First Line Business Practice Location Address:
NR OHSU NMC PTS DET Y
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-953-7700
Provider Business Practice Location Address Fax Number:
757-953-7589
Provider Enumeration Date:
01/09/2006