| NPI | 1023415122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN MUSGRAVE Associate Director/Legal Council 410-402-1123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: DC CPA-0076) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2015-11-05 |