| NPI | 1871709899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKIA DEWITT BEVERLY Office Administrator 757-484-2001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101224920) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2011-09-09 |