| NPI | 1104840453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SHARKEY Manager, Professional Fee Billing 443-777-7142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-11-13 |