| NPI | 1689958860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS PRINCE Director 757-983-5475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2022-04-29 |