| NPI | 1356992853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN M PACK Authorized Official/Owner 804-617-0687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2019-09-25 |