Individual
MS. VALERIA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOTR/L
Contact information
Practice address
514 LAUREL BROOK DR APT C, BRICK, NJ 08724-6015
(856) 220-9630
Mailing address
514 LAUREL BROOK DR APT C, BRICK, NJ 08724-6015
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
46TR403100
NJ
Other
Enumeration date
08/09/2012
Last updated
08/09/2012
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