| NPI | 1023005139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI E RUNYON Managed Care Coordinator 540-855-3554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: VA OH667) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2022-12-30 |