Provider First Line Business Practice Location Address:
1712 E BROAD STREET
Provider Second Line Business Practice Location Address:
JENCARE NEIGHBORHOOD MEDICAL SHOCKOE BOTTOM, LLC
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-344-9848
Provider Business Practice Location Address Fax Number:
804-344-5644
Provider Enumeration Date:
11/15/2012