| NPI | 1255791448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITA JUNE NEELY Administrator 703-222-2773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0101047432) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-03-01 |