| NPI | 1558603688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRINGTON MENZEL Executive Director 434-944-9807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 0701002055) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2013-03-27 |