Organization
WOODLAKE VILLAGE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER DIANE CLARK MD (OWNER)
(804) 639-0717
Entity
Organization
Contact information
Practice address
14732 VILLAGE SQUARE PL, MIDLOTHIAN, VA 23112-2253
(804) 639-0717
(804) 639-0767
Mailing address
14732 VILLAGE SQUARE PLACE, MIDLOTHIAN, VA 23112-2253
(804) 639-0717
(804) 639-0767
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101056329
VA
Other
Enumeration date
03/26/2007
Last updated
05/22/2008
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