Individual
AUTUMN VICTORIA JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
305 LANGDON ST, SOMERSET, KY 42503-2750
(606) 679-7441
Mailing address
124 C MCKINLEY RD, JAMESTOWN, KY 42629
(270) 566-2453
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05621
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/28/2021
Last updated
07/10/2024
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