| NPI | 1194905539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA D RANDOLPH Insurance/Financial Coordinator 757-412-2235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401008908) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |