| NPI | 1346423852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAE SPENCER Office Manager 757-874-8919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: VA 04001007788) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2007-12-07 |