Organization
LIVEWIRE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HENRY CLIFFORD (PRESIDENT/OWNER)
(804) 971-7672
Entity
Organization
Contact information
Practice address
4900 W CLAY ST, RICHMOND, VA 23230-2804
(804) 937-9001
Mailing address
4900 W CLAY ST, RICHMOND, VA 23230-2804
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
01/15/2013
Last updated
01/15/2013
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