| NPI | 1609168905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHENEKIA M BAKER Manager 757-685-7232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: VA 134552-8080) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2011-06-02 |