Provider First Line Business Practice Location Address:
109 BEE ST.
Provider Second Line Business Practice Location Address:
DEPT OF SURGERY (112) CHARLESTON VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-239-7068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2006