| NPI | 1528213931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK GRIFFIN Owner 757-831-3919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: 305r00000x) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2008-11-26 |