| NPI | 1588930655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE RENEE LYKINS Owner/President 804-741-4433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: VA 0104000673) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2012-03-22 |