| NPI | 1386893592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS J ACOSTA Office Manager 757-826-2102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101019396) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2011-04-18 |