| NPI | 1699403014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JAMES BUNTON CEO 804-506-0526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2023-06-25 |