| NPI | 1750538203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYBETH WICKER President 804-320-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401410286) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2008-08-26 |