| NPI | 1104162346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C. FIDGEON President 540-710-6085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 158 02 029) |
| Enumeration Date | 2012-12-17 |
| Last Update Date | 2012-12-17 |