| NPI | 1043236664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE NUGENT Officer/Authorized Official 804-287-7878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: VA OH 702) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2020-03-25 |