NPI | 1700104536 |
---|---|
Entity Type | Organization |
Authorized Contact | VICTOR M MOODY Owner 757-224-7986 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1095-05) |
Enumeration Date | 2010-05-04 |
Last Update Date | 2010-05-04 |