| NPI | 1366323941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKSON GREEN Administrator 804-286-6224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QP2300X Clinic/Center, Primary Care | |
| 208000000X Pediatrics | |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2025-09-10 |