| NPI | 1164814612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD A MARTIN Regional Director 757-962-0748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201920) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 207QA0401X) |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2015-11-17 |