| NPI | 1104697366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARA HOLTON CEO/President 410-266-8049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2026-07-08 |