| NPI | 1073063202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL WILLIAM LUSTER COO 434-282-2294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: VA 2877-02-001) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2016-10-12 |