| NPI | 1568543411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA GOULD Office Manager 804-346-1612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101046045) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101235753) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |