| 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 |