| NPI | 1821113846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANNE WALSH Director Of Operations 703-256-8744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |