| NPI | 1063871309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND LEE HOWARD Manager 804-475-2441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA S4477073) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-02-15 |