| NPI | 1407060114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA RENEE DAVIS Physician President 703-780-7010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101057044) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2015-03-10 |