| NPI | 1265534382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHUJA U KHAN Owner President 804-737-7804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0101053528) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-10-13 |