| NPI | 1609052109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE C WILLIAMS Credentialing Coordinator 757-722-9961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: VA 0001101054) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-01-14 |