Individual
MS. WENDY BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
260 TINY RD, SOUTH HILL, VA 23970-4916
(434) 917-4292
(434) 447-2604
Mailing address
260 TINY RD, SOUTH HILL, VA 23970-4916
(434) 917-4292
(434) 447-2604
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
T69-50-5052
VA
Other
Enumeration date
10/31/2018
Last updated
10/31/2018
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