| NPI | 1902973423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CISSY PAUL POTTANAT Owner President 703-532-9411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101056325) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2023-05-28 |