| NPI | 1649669680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK ANTHONY DAVIS Owner 804-519-4362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 2426) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2015-01-14 |