Organization
KWI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAILY WEISS (HEAD ATHLETIC TRAINER)
(423) 636-7301
Entity
Organization
Contact information
Practice address
642 TANGLEWOOD DR, LYNCHBURG, VA 24502-5673
(434) 660-7203
Mailing address
642 TANGLEWOOD DR, LYNCHBURG, VA 24502-5673
(434) 660-7203
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2016
Last updated
10/26/2016
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