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Individual

LATRICE PENNY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
12163 OLD SALEM CT, WOODBRIDGE, VA 22192-6258
(410) 297-1821
Mailing address
12163 OLD SALEM CT, WOODBRIDGE, VA 22192-6258
(410) 297-1821

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
P500488368942
MD

Other

Enumeration date
11/08/2023
Last updated
11/08/2023
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