| NPI | 1497031975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFRY HOLLIS CEO 540-347-9220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003697) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2011-10-27 |