| NPI | 1124323027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS D SPRUILL Owner 757-606-3945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 305S00000X) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2011-03-03 |