| NPI | 1114305034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANNE E PRESTON-JOSEY Owner, Clinical Director 757-472-4982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 0701004100) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2015-05-12 |