| NPI | 1164426045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARA HOLTON CEO/President 410-504-4004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2024-02-05 |