| NPI | 1124889811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA AZUCENA CORTEZ Manager 703-989-9482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-06-27 |