| NPI | 1518471671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLENE SHANK Administrator 757-831-4546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0104001667) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2018-06-16 |