| NPI | 1104298389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMALITA YVONNE KOVACH-WATTS CEO 757-372-3534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 309971) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2015-10-27 |