| NPI | 1124251491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND IGLECIA Owner 757-460-7189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101057390) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101057390) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2010-07-07 |