| NPI | 1932285111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PROFFITT Credentialing/Enrollment 804-533-2357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2022-06-03 |