| NPI | 1083662753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER A JACONSKI Billing Representative 301-953-1266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D47483) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2009-05-21 |