| NPI | 1205974656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN EDWARD BRADY President 757-223-0124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0591153-2) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2021-03-19 |