| NPI | 1669804183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASHONDRA DENISE RICE Founder/President 757-268-6586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2013-08-07 |