Provider First Line Business Practice Location Address: 
235 CANTRELL AVE
    Provider Second Line Business Practice Location Address: 
ANESTHESIA DEPARTMENT
    Provider Business Practice Location Address City Name: 
HARRISONBURG
    Provider Business Practice Location Address State Name: 
VA
    Provider Business Practice Location Address Postal Code: 
22801-3248
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
540-879-7063
    Provider Business Practice Location Address Fax Number: 
540-879-2659
    Provider Enumeration Date: 
02/08/2007