| NPI | 1427355288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFRED LARRY BOULWARE Inte RN Ist Owner 540-548-2284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: VA 0101236689) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2011-02-14 |