NPI | 1477766020 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHELLE ELIZABETH KINGSBURY Owner 757-460-2171 |
Organization Subpart ? | No |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101047049) |
Enumeration Date | 2007-05-08 |
Last Update Date | 2008-05-14 |