| NPI | 1770980757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LEE President 757-366-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: VA 0101241301) |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2015-10-16 |