| NPI | 1801630801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRA LUEVANO Program Director 703-420-8992 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-06-24 |