| NPI | 1538502018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON L SCOTT Owner 757-825-6280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 0401005160) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2013-04-15 |