Provider First Line Business Practice Location Address:
3636 HIGH STREET
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-889-5112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2007