| NPI | 1871775163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW BRADLEY VAN AMBERG President 757-498-5433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: VA 0104001846) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2008-06-23 |