| NPI | 1922494459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALISTA PETRIE Case Manager 703-938-1421 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine |
| Additional Taxonomies | 208600000X Surgery |
| 208VP0014X Pain Medicine, Interventional Pain Medicine | |
| 261QA1903X Clinic/Center, Ambulatory Surgical | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2024-04-16 |