| NPI | 1063502169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT STEPHEN PODOLSKY Physician President 703-709-7610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X (Licence: VA 0101055000) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-04-28 |