| NPI | 1114075124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN LUCAS Dms 804-270-2150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: VA 213000031) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |