| NPI | 1497053557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WILLIAM CLARK Medical Director 757-873-1880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101050712) |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2011-03-14 |