| NPI | 1912784257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA MORAN Member 757-461-3141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2023-11-21 |