| NPI | 1124097621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITA S. BENNETT CEO 804-783-2505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2021-11-02 |