Provider First Line Business Practice Location Address:
58 CARROLL ST SUITE 3
Provider Second Line Business Practice Location Address:
DEPT OF RUSSELL COUNTY MEDICAL CENTER
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-883-8340
Provider Business Practice Location Address Fax Number:
276-883-8341
Provider Enumeration Date:
10/18/2016