Individual
MRS. MARY KINGERY ALTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 MCDOWELL AVE NW, ROANOKE, VA 24016-1225
(540) 343-3007
Mailing address
301 ELM AVE SW, ROANOKE, VA 24016-4001
(540) 345-9841
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701004847
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437137734
—
VA
Enumeration date
06/10/2010
Last updated
06/10/2010
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