| NPI | 1508153602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY RANDALL LEWIS Physician 703-273-3613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101028949) |
| Enumeration Date | 2011-07-09 |
| Last Update Date | 2011-07-09 |