Provider First Line Business Practice Location Address:
3150 CLINCH STREET SUITE 204
Provider Second Line Business Practice Location Address:
WASHINGTON SQUARE CLINIC
Provider Business Practice Location Address City Name:
RICHLANDS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-964-6711
Provider Business Practice Location Address Fax Number:
276-964-2240
Provider Enumeration Date:
09/27/2006