Individual
TERESA REDFORD-BANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22011 GENITO RD, AMELIA COURT HOUSE, VA 23002-5309
(804) 561-4143
Mailing address
PO BOX 299, AMELIA COURT HOUSE, VA 23002-0299
(804) 561-4143
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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