| NPI | 1457482622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ALLYN GARDNER President 757-220-3311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103000917) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2010-12-08 |