| NPI | 1841315058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE H. HAWKINS Credentialing Coordinator 757-232-8769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101046873) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2010-02-17 |