| NPI | 1164644142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER ROBERT DEXHEIMER Owner 410-531-6550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MD S01181) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2008-07-21 |