| NPI | 1417082231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE M SANBORN Medical Biller 703-730-4848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101048180) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101221455) |
| 208600000X Surgery (Licence: VA 0101236256) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2009-08-21 |