| NPI | 1912329749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROB MARINO Executive Director 540-347-0394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2020-10-05 |