Individual
SERITA DANIELLE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2557 WILLIE CRAIG ROAD, BASSETT, VA 24055
(276) 224-3518
Mailing address
2557 WILLIE CRAIG RD, BASSETT, VA 24055-3310
(276) 224-3518
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
T63326190
VA
Other
Enumeration date
03/06/2018
Last updated
03/06/2018
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