| NPI | 1164794491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM HARVEY WALLS President 757-548-1919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401007229) |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2012-02-02 |