Individual
CALLIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4991 LAKE BROOK DR STE 300, GLEN ALLEN, VA 23060-9293
(804) 837-4578
(855) 849-1894
Mailing address
4991 LAKE BROOK DR STE 300, GLEN ALLEN, VA 23060-9293
(804) 837-4578
(855) 849-1894
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/08/2013
Last updated
05/08/2013
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