| NPI | 1316258791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | W ROBERT WISMAN Physician 540-345-8124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0101014128) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2010-07-09 |