| NPI | 1780740811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARISSE BARKSDALE Owner 757-216-8097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 2006210163R) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2008-06-17 |