| NPI | 1356947295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARIE JACQUES Managing Member 703-261-6758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |