| NPI | 1316162456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCY L. MCCABE Administrator 703-719-5828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0401007980) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-08-22 |