Individual
KEVIN HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 N PLAINS DR, PETERSBURG, VA 23805-9110
(804) 647-3283
Mailing address
122 N PLAINS DR, PETERSBURG, VA 23805-9110
(804) 647-3283
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
T65434407
VA
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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