| NPI | 1861836157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE FITCHETT REYNOLDS Manager 757-927-2238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0443000009) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2013-04-17 |