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Individual

LAVORA DAWN BRADLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1305 MAPLE AVE, ELMIRA, NY 14904-3045
(607) 259-2800
Mailing address
1305 MAPLE AVE, ELMIRA, NY 14904-3045
(607) 259-2800

Taxonomy

Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
15433672
ID
TX
Enumeration date
08/09/2020
Last updated
08/09/2020
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