| NPI | 1568897353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA MCTIGHE PAGE Asst. Ad Of Sports Medicine 434-395-2965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2013-09-11 |