| NPI | 1164181145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY W. LUCAS CEO 703-677-1035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-12-17 |
| Last Update Date | 2021-12-17 |