| NPI | 1083095491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEBLE WONGEL DEJENE President 703-261-7001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2015-06-11 |