| NPI | 1912368101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YARED W ENDAILALU Dr. 703-646-4841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101254201) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: VA 0101254201) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2016-03-15 |