| NPI | 1275267106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL OUTLAW Owner 757-748-4643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2022-07-15 |