| NPI | 1003113168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY M TILLEY Sr. Credentialing Specialist 804-306-1203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2025-08-14 |