| NPI | 1205221934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY A DAVIS CEO 757-589-7677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MD lc5858) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2015-03-31 |