Individual
SAINT STANLEY CLARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2293 BRODNAX ROAD, BRODNAX, VA 23920
(804) 824-0305
(434) 636-2998
Mailing address
PO BOX 365, BRODNAX, VA 23920-0365
(804) 824-0305
(434) 636-2998
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T69526555
VA
Other
Enumeration date
11/01/2018
Last updated
11/01/2018
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