| NPI | 1265851836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOVAT C BATES Owner 804-919-1126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 2059-010001) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2014-04-10 |