| NPI | 1821291584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN HELLSTROM Executive Director 757-428-5601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: VA 0201004157) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2020-08-22 |