| NPI | 1558774679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORETHA RENEE SELBY-DIGGS Cheif Executive Officer 757-839-4243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 2088-03-001) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2014-06-05 |