| NPI | 1780079558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILIJA STEVEN RAKARIC Director / Incorporator 540-908-3095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101054605) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2015-04-20 |