Provider First Line Business Practice Location Address:
1317 BALLAHACK RD. STE 100
Provider Second Line Business Practice Location Address:
CAPT W.L. MCGONAGLE BRANCH CLINIC NSA NORTHWEST
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23322-2463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-953-6259
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2010