Individual
MARY LETICIA WILCOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
52 BRIARWOOD LN, ROCKY GAP, VA 24366-7112
(210) 410-1507
Mailing address
PO BOX 509, BLUEFIELD, VA 24605-0509
(210) 410-1507
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/09/2019
Last updated
09/15/2019
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