| NPI | 1225590102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY CHRISTOPHER HARRIS Sole Memeber/Authorized Official 757-272-2345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 251X00000X |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2020-02-17 |