| NPI | 1558614958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE MARTIN Practice Manager 757-481-2313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2012-10-23 |