| NPI | 1104273952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLUWAROTIMI WILLIAMS IKUSIKA Adeministrator 301-446-3070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2016-05-23 |