| NPI | 1922310572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS LEECOST Director 804-643-8667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: VA 0103000319) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2011-10-21 |