| 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 |