| NPI | 1497902670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE M BOTTS Office Manager 804-777-9908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: VA 0101050490) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2014-04-18 |