| NPI | 1184804163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAHAB M. EHTESHAM Physician 276-679-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101225223) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2010-02-01 |