| NPI | 1073997953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORTHEA MORNET KIRBY Service Facilator 276-252-1043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 45-0674833) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-07-10 |