Individual
MATTHEW WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1215 LEE ST., PO BOX 801340, CHARLOTTESVILLE, VA 22908-1340
(434) 243-9552
Mailing address
1215 LEE ST., PO BOX 801340, CHARLOTTESVILLE, VA 22908-1340
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/23/2015
Last updated
06/21/2024
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