| NPI | 1376715011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON SHEPPARD Office Manager 804-464-1852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0401410103) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2008-04-01 |