Individual
LYDIA RUTLEDGE VOLLAVANH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
54 CEDAR ST, MILLBURN, NJ 07041-2002
(973) 376-1263
Mailing address
54 CEDAR ST, MILLBURN, NJ 07041-2002
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/03/2015
Last updated
08/03/2015
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