| NPI | 1568190072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMEELAH JOHNSON Medical Records Manager 571-315-0014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center Public Health, State or Local |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2024-05-10 |