| NPI | 1912242124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY ANTWON OLDS Chief Operations Officer 757-595-8008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 1571-01-001) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2015-04-07 |