| NPI | 1750462735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY RICHARD WARE President/CEO 703-823-3660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0101050807) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |