Provider First Line Business Practice Location Address:
1221 LEE ST PRIMARY CARE RM G101B
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:
434-297-4298
Provider Business Practice Location Address Fax Number:
434-297-4238
Provider Enumeration Date:
06/28/2021