| NPI | 1073052114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH BRATTON COO 804-396-6412 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |