Individual
ORITSEMATOSAN AYU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6501 LOISDALE CT, SPRINGFIELD, VA 22150-1826
(703) 922-1530
Mailing address
6501 LOISDALE CT, SPRINGFIELD, VA 22150-1826
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
0230027933
VA
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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