| NPI | 1992721153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT STEPHEN OLDHAM Managing Physician 434-200-5925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101028991) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2008-11-12 |