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Individual

BLAIR BOLTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
707 MOUNT CROSS RD, DANVILLE, VA 24540-5905
(434) 791-5600
Mailing address
110 MANCHESTER AVE, DANVILLE, VA 24541-2631

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
YRW8146M64415
ANTHEM
VA
Enumeration date
08/06/2017
Last updated
08/06/2017
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