| NPI | 1306147798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY LEE INSLEY Director 757-842-6757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: VA 101239530) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 101016018) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2013-07-16 |