| NPI | 1104078799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA E PAYNE Practice Manager 540-432-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: VA 0101244269) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2024-06-26 |