| NPI | 1982703708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE ANTONIO GHOLSON Chief Executive Officer 757-223-9177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X (Licence: VA 666-03-001) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-08-22 |