| NPI | 1083089197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA WALISZEWSKI Registered Dietitian 804-815-4269 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 961152) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2015-12-01 |