Individual
DESARAE LATEVA JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4357 ROARK MILL RD, HURT, VA 24563-3308
(434) 420-8823
(434) 324-0568
Mailing address
4357 ROARK MILL RD, HURT, VA 24563-3308
(434) 420-8823
(434) 324-0568
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
T60727635
VA
Other
Enumeration date
02/10/2020
Last updated
02/10/2020
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