| NPI | 1124058946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RUSSELL MOORE Medical Director 410-296-6232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MD A1302) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2008-03-16 |