| NPI | 1174712301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE D LE President 703-642-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 0101237697) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2007-10-24 |