Provider First Line Business Practice Location Address:
1215 LEE STREET
Provider Second Line Business Practice Location Address:
MAIL STOP 'OTOLARYNGOLOGY'
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22908-0816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-924-5700
Provider Business Practice Location Address Fax Number:
434-924-1736
Provider Enumeration Date:
03/27/2021