| NPI | 1710408117 |
|---|---|
| Doing Business As | DR. WICKIZER |
| Entity Type | Organization |
| Authorized Contact | BOYD R WICKIZER President 804-938-0264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: VA 0101047692) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2017-07-06 |