| NPI | 1083157499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN LE TRAN Medical Director 540-508-0779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0101256096) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2016-12-02 |