Organization
IVY FAMILY MEDICINE, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LILY WISE HARGROVE MD (OWNER)
(434) 466-8363
Entity
Organization
Contact information
Practice address
2 BOARS HEAD PL, SUITE 110, CHARLOTTESVILLE, VA 22903-4611
(434) 466-8363
Mailing address
516 ROOKWOOD PL, CHARLOTTESVILLE, VA 22903-4734
(434) 466-8363
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0101057199
VA
Other
Enumeration date
01/12/2011
Last updated
04/18/2011
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