| NPI | 1912463472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANAL MOHARRAM Owner 804-615-5060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2023-10-18 |