| NPI | 1912445362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY LOUGHREY State Director Of Aba Services 804-562-9997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 0133000759) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2019-09-18 |