| NPI | 1922016278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK QUARLES Medical Doctor 757-490-6637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101239928) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2014-08-20 |