Provider First Line Business Practice Location Address:
524 SOUTHPARK BOULEVARD
Provider Second Line Business Practice Location Address:
JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-504-7980
Provider Business Practice Location Address Fax Number:
804-504-7991
Provider Enumeration Date:
11/13/2006