| NPI | 1285169011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GOITOM GEBRETINSAE FESSHATSION President 804-908-6090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: VA 002-00627389) |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2017-04-30 |