| NPI | 1619355922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEYSHA J AMONSMILES Owner 757-714-0796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: VA 0019011604) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |