Individual
VANESSA LEE BUNTING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMT
Contact information
Practice address
403 PICHMOND PATH, VILLA RICA, GA 30180-6602
(770) 255-8947
Mailing address
403 PICHMOND PATH, VILLA RICA, GA 30180-6602
(770) 255-8947
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT001545
GA
Other
Enumeration date
08/21/2007
Last updated
08/21/2007
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