| NPI | 1194839704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZATERA A SPENCER Owner/Administrator 757-966-9978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: VA 558) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2008-06-23 |