| NPI | 1013320712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN N SKIRVEN CEO 757-222-4510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 1060267354) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |