| NPI | 1689863565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP J. ODONNELL Medical Director 703-336-9191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101043748) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2011-03-28 |