Organization
JUSTIN'S BLACK TEA AND BREAD, A TEA ROOM LLC
Active
Other names
Peoples Healthcare Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN PROCTOR (PRESIDENT CEO)
(703) 589-5432
Entity
Organization
Contact information
Practice address
1001 PROVIDENCE ST, STE 203, STAFFORD, VA 22554-8300
(703) 589-5432
(540) 657-9732
Mailing address
1001 PROVIDENCE ST, STE 203, STAFFORD, VA 22554-8300
(703) 589-5432
(540) 657-9732
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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