| NPI | 1407253503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON RYAN JOHNSON President 757-493-1965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101239405) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2015-04-29 |