| NPI | 1457546434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE LYNN BOONE President 804-264-0224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401410483) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2007-09-12 |