| NPI | 1922122605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY WELLINGTON WILSON Physician 434-947-5918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101030315) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |