| NPI | 1922345313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRON SIMON Chief Medical Director 703-430-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: VA 0101232169) |
| Additional Taxonomies | 261QC1800X |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2013-01-07 |