Provider First Line Business Practice Location Address:
CAROLINE DETENTION FACILITY
Provider Second Line Business Practice Location Address:
11093 SW LEWIS MEMORIAL DRIVE
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-633-0043
Provider Business Practice Location Address Fax Number:
866-475-9337
Provider Enumeration Date:
08/13/2019