| NPI | 1780328591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE FIELDS CFO 804-219-6361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2022-04-27 |