| NPI | 1639836950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LERLA GEORGETTE JOSEPH Practice Owner 804-386-7855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2023-03-24 |