| NPI | 1265715601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA LYNN HEBERLING Office Manager 757-436-0026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0401006063) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2011-10-06 |