| NPI | 1528735107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE BOGUE Credentialing 703-776-0108 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2021-08-23 |