| NPI | 1053996199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY SMITH Program Director 410-304-6670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2025-06-06 |