Organization
A'DIVA'S GLO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA STREET (OWNER)
(276) 734-3421
Entity
Organization
Contact information
Practice address
28 MOSS ST N, MARTINSVILLE, VA 24112-2636
(276) 734-3421
Mailing address
28 MOSS ST N, MARTINSVILLE, VA 24112-2636
(276) 734-3421
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/02/2022
Last updated
09/02/2022
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