| NPI | 1194005512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD LEE BROADWATER Doctor 410-628-2140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: MD D15200) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2011-08-17 |