| NPI | 1083019525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHWETHA RODRIGUES Owner/Doctor 804-748-2555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0401410819) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2015-01-12 |