| NPI | 1104002112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA KAY FULLER CEO/Administrator 757-576-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: VA 0001210835) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2008-01-21 |