| NPI | 1760633283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM SMITH Administrator 703-777-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: VA 908832094382904) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2008-10-02 |