Provider First Line Business Practice Location Address: 
EMERGENCY DEPARTMENT
    Provider Second Line Business Practice Location Address: 
1901 TATE SPRINGS RD
    Provider Business Practice Location Address City Name: 
LYNCHBURG
    Provider Business Practice Location Address State Name: 
VA
    Provider Business Practice Location Address Postal Code: 
24501
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
434-200-7387
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/24/2015