| NPI | 1760664007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL ECCLESTON Administrator 703-230-0347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101050406) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2022-08-25 |