| NPI | 1750131934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRANDA MOORE Senior Contracts Administrator 703-674-5016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2024-03-22 |