| NPI | 1114491073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD J BROUILLETTE Regional Medical Director 301-645-1523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2025-06-02 |