| NPI | 1649714155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIAN DECOSIMO Physician , Sole Member Owner 703-859-5225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: VA 0101053044) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2017-01-09 |