Provider First Line Business Practice Location Address:
1 HOSPITAL DR RM 1808
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22908-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-409-9493
Provider Business Practice Location Address Fax Number:
434-924-1797
Provider Enumeration Date:
12/01/2025