| NPI | 1568890374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WAYNE TATOM Physician 434-239-3949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0102037129) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2013-10-15 |