| NPI | 1124158662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH L GOFREED Medical Director 703-243-6700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101036617) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2014-06-19 |