Individual
OLIVE ALFRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 GLASSY LAKE DR, VIRGINIA BCH, VA 23453-7027
(757) 281-8383
Mailing address
1701 GLASSY LAKE DR, VIRGINIA BCH, VA 23453-7027
(757) 281-8383
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/16/2017
Last updated
07/21/2022
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