| NPI | 1417168592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TESHANA DENISE HENDERSON Associate Director 804-303-8393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 758-14-003) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |