| NPI | 1477934727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAPHNEY JACKSON Credentialing Manager 703-498-2773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: VA S4081867) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: VA S4081867) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2015-06-12 |