| NPI | 1871991000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LARON SHAW Owner 804-775-4559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: VA 0101245920) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2014-12-22 |