| 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 |