| NPI | 1174073910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMELLE STACIAN REDDING Owner 443-829-1530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MD R133694) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2023-02-09 |