| NPI | 1154898997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN LOCH Credentialing Billing Manager 703-249-9079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2018-10-31 |