| NPI | 1124200779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE ELLIS Insurance Coordinator 804-233-9661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101021333) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2009-03-13 |