Provider First Line Business Practice Location Address:
1301 RICHMOND AVE
Provider Second Line Business Practice Location Address:
WESTERN STATE HOSPITAL
Provider Business Practice Location Address City Name:
STAUNTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24401-9146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-332-8121
Provider Business Practice Location Address Fax Number:
540-332-8065
Provider Enumeration Date:
09/19/2005