| NPI | 1639563414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOGAN S BOSIGER Practice Manager 434-851-2052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101102727) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2019-05-28 |