| NPI | 1003205907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN LESLIE BRADLEY-POFF Program Administrator 410-225-7696 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: MD 905390) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2015-01-15 |