Individual
TERESA RENA WILES VANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
659 AUBURN AVE NE STE G18, ATLANTA, GA 30312-1977
(470) 322-5619
Mailing address
1578 VAN VLECK AVE SE, ATLANTA, GA 30316-2150
(703) 473-7338
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT010261
GA
Other
Enumeration date
11/07/2019
Last updated
11/07/2019
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