| NPI | 1386180149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM-NGAN DO Owner 571-278-2096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0401414229) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-01-17 |