| NPI | 1083024061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON HERZOG Chief Executive Officer 804-767-8693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: MO 26D2037986) |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: IN 1806) |
| 291U00000X Clinical Medical Laboratory (Licence: MA 22D2133374) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2022-08-25 |