Provider First Line Business Practice Location Address:
1600 E WOODROW WILSON AVE
Provider Second Line Business Practice Location Address:
SOUTH CENTRAL VA HEALTH CARE NETWORK (VISN 16 - 10N16)
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-364-7932
Provider Business Practice Location Address Fax Number:
601-364-7894
Provider Enumeration Date:
08/19/2006