Individual
MONIESHA AVITA JAVON BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
508 LITTLE MARGARET LN, HENRICO, VA 23075-1647
(804) 822-8661
Mailing address
508 LITTLE MARGARET LN, HENRICO, VA 23075-1647
(804) 822-8661
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
09/09/2019
Last updated
09/09/2019
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