| NPI | 1174595870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON D LANGE Assistant Manager 410-254-2055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: MD P01182) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2021-01-21 |