| NPI | 1477695740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND C LACKORE Owner 757-481-3366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101036490) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-08-22 |