| NPI | 1083239982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA BEATTY Provider/Authorized Representative 757-617-5181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-07-06 |