| NPI | 1841747086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAN CHI THI NGUYEN Owner 240-601-4097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 305S00000X Point of Service (Licence: DC DI100000639) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2016-09-06 |