Provider First Line Business Practice Location Address:
4452 CORPORATION LANE
Provider Second Line Business Practice Location Address:
VIRGINIA BEACH HEALTH DEPARTMENT
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-518-2672
Provider Business Practice Location Address Fax Number:
757-518-2640
Provider Enumeration Date:
09/08/2006