NPI | 1730405879 |
---|---|
Entity Type | Organization |
Authorized Contact | KIMBERLY DIANE INGRAM SODERBERG President 757-368-7546 |
Organization Subpart ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101241129) |
Enumeration Date | 2010-04-14 |
Last Update Date | 2010-04-14 |