Provider First Line Business Practice Location Address:
12480 DILLINGHAM SQUARE
Provider Second Line Business Practice Location Address:
INOVA INTERNAL MEDICINE - LAKE RIDGE
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-5258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-494-6111
Provider Business Practice Location Address Fax Number:
703-497-0476
Provider Enumeration Date:
10/31/2005