| NPI | 1245394394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN JOYNER Office Manager 757-591-9572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101050712) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101236493) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-08-22 |