| NPI | 1962025502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESMERALDA ESQUIVEL SORIANO President/Executive Director 757-488-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center VA |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-05-18 |