| NPI | 1730407123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WM. TRAVIS CROCKER CEO 804-648-0671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 709-04) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2010-05-10 |