| NPI | 1104068790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA A COATS-WALTON Medical Director 301-809-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D0051777) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2018-08-27 |