| NPI | 1164456398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE VANESSA HEGADORN Practice Manager 540-371-1664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201074) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-08-22 |