| NPI | 1104240845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN WALTROUS Owner 240-460-4661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MD D77249) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2014-02-18 |