| NPI | 1770846800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRECE SCOTT LLC Member/Owner 757-319-3662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 302F001) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2021-06-22 |