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1972808335
JACK M. COSTA, M.D., P.C.
FAIRFAX, VA
NPI
1972808335
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Entity Type
Organization
Authorized Contact
JACK M. COSTA
Owner
703-391-2516
Organization Subpart ?
No
Primary Taxonomy
174400000X Specialist
(Licence: VA 0101028288)
Enumeration Date
2011-01-17
Last Update Date
2011-01-17
Business Address
JACK M. COSTA, M.D., P.C.
3650 JOSEPH SIEWICK DR SUITE 202
FAIRFAX, VA 22033-1710
Phone number: 703-391-2516
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Mailing Address
JACK M. COSTA, M.D., P.C.
3650 JOSEPH SIEWICK DR SUITE 202
FAIRFAX, VA 22033-1710
Phone number: 703-391-2516
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