| NPI | 1255194189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARASINH PHOUMMITHONE MAYARD A/R & Operations Manager 703-395-6410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2024-02-02 |
| Last Update Date | 2024-09-10 |