| NPI | 1346474707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISSA SHAE PARKS Office Manager 276-227-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202346) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2021-03-02 |