| NPI | 1205589017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA MAMINA KELLY-COLEMAN Owner 757-324-5985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2022-02-01 |