Individual
MS. CRYSTAL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3700 S MAIN ST, BLACKSBURG, VA 24060-7017
(540) 951-1111
Mailing address
506 ESSEX CT # 1, BLACKSBURG, VA 24060-6464
(804) 429-7185
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A69874069
VA
Other
Enumeration date
12/29/2021
Last updated
12/29/2021
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