| NPI | 1588826929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVI K TITHA Physician 276-964-6711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101235493) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2008-10-24 |