| NPI | 1942479662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA M BOURAEE Owner 757-234-2905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric (Licence: VA 0103301022) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2020-03-02 |