| NPI | 1063675189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BABAK IMANOEL Medical Director 410-871-3005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: MD 903435) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2012-04-15 |