| NPI | 1487944070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET M PETITTO Manager 703-491-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0104000545) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2024-04-11 |