| NPI | 1104174002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINE GARTLITZ Clinic Director 410-341-3420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MD 5241) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2019-09-25 |