Individual
DOMONIC TEHERAN SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 BREWER AVE, SUFFOLK, VA 23434
(757) 288-6833
(757) 272-0626
Mailing address
102 BREWER AVE, SUFFOLK, VA 23434-5602
(757) 602-0544
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T60356518
VA
Other
Enumeration date
09/13/2017
Last updated
09/13/2017
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