| NPI | 1013121508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA TIRADO Physician 703-556-9318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101038420) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2011-07-14 |