| NPI | 1114089588 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA LEIGH SIVER Health Services Technician 757-483-8596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |