Provider First Line Business Practice Location Address:
659 HOSPITAL RD
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BUILDING A, SUITE 201
Provider Business Practice Location Address City Name:
TAPPAHANNOCK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-443-6130
Provider Business Practice Location Address Fax Number:
804-443-6129
Provider Enumeration Date:
06/21/2005