| NPI | 1649748526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PROFFITT Credentialing & Enrollment 804-533-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2022-06-02 |