| NPI | 1467044560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEYSHA RENEE JENKINS Np/Owner 757-775-8837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2021-03-20 |