| NPI | 1093830267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVETTE LYNN COBB Practice Administrator 804-288-9466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101045793) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2018-03-08 |