| NPI | 1285185538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHUCK D CODER Provider Enrollment COO Rdinator 804-835-2069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2023-09-26 |