| NPI | 1154628220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHENEKIA M BAKER Rvt/Technical Director 757-685-7232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: VA 127157) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2011-02-25 |