| NPI | 1548650716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTY ANN MARTINEZ Billing Specialist 434-296-9596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101237327) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0102202110) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2015-01-27 |