| NPI | 1225389893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMMA HOLTON Provider Enrollment Coordinator 804-643-2287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: VA 0101035155) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2012-09-24 |