| NPI | 1396774667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN L. JOHNSON President 757-455-5009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0101042937) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-08-22 |