| NPI | 1003108333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA A BIGELOW Office Manager 757-547-5105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0401003350) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2011-05-04 |