| NPI | 1003175894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINA MARIE NOBLE-MCINNIS Owner 804-554-1899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 0701004698) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2012-05-14 |