| NPI | 1083146302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD MARTIN Owner 757-933-2660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101049004) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-03-28 |