| NPI | 1669420048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY J.R. JACOBS President/CEO 804-239-8208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 3123) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2009-07-12 |