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1971 University Blvd Lynchburg VA 24515-0002 | |
(972) 367-4845 | |
Not Available |
Full Name | |
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Speciality | General Practice |
Location | 1971 University Blvd, Lynchburg, Virginia |
Authorized Official Name and Position | Mouzon Bass (ADMINISTRATOR) |
Authorized Official Contact | 9723674845 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5050 Spring Valley Rd Dallas TX 75244-3995 Ph: () - | 1971 University Blvd Lynchburg VA 24515-0002 Ph: (972) 367-4845 |
NPI Number | 1750848644 |
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Provider Enumeration Date | 02/27/2019 |
Last Update Date | 02/27/2019 |
Identifier | Type | State | Issuer |
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1750848644 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Primary |
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