| NPI | 1962263459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER MARK VANRAAM COO 757-303-7221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2024-08-07 |