Individual
LAVONNA SMITH-TYLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10500 NAPOLEON ST, FREDERICKSBURG, VA 22408-8089
(540) 373-6496
(540) 373-6496
Mailing address
10500 NAPOLEON ST, FREDERICKSBURG, VA 22408-8089
(540) 455-1297
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
T63406787
VA
Other
Enumeration date
02/01/2018
Last updated
03/17/2018
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