| NPI | 1457740458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT B HANSEN President 757-461-3141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0101041467) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-01-13 |