| NPI | 1104835933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN ALLEN GRUBB Owner 276-773-8145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0101225439) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2008-04-20 |