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Organization
KENT VILLAGE MEDICAL CENTER, LLC
Active
Organization
KENT VILLAGE MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FEDERICO CARLOS GONZALES M.D. (OWNER)
(703) 715-9700
Entity
Organization
Contact information
Practice address
112 KENT VILLAGE SQ, MANASSAS PARK, VA 20111-4155
(703) 715-9700
(703) 715-0202
Mailing address
3700 JOSEPH SIEWICK DR, SUITE 401, FAIRFAX, VA 22033-1744
(703) 715-9700
(703) 715-0202
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
0101028651
VA
Other
Enumeration date
07/08/2014
Last updated
07/08/2014
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