| NPI | 1417981648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE VANESSA HEGADORN Practice Manager 540-371-1664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110001678) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-07-21 |