| NPI | 1215052048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID LEE STANLEY Franchisee 804-745-9402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: VA 1101 000684) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |