Individual
SANDRA C CORP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
100 MAPLE AVE E, VIENNA, VA 22180-5723
(703) 938-5300
(703) 242-0726
Mailing address
100 MAPLE AVE E, VIENNA, VA 22180-5723
(703) 938-5300
(703) 242-0726
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102036916
VA
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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