| NPI | 1124704317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA M MADLOCK Partner 531-721-5586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA |
| Additional Taxonomies | 251E00000X Home Health |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2023-06-23 |