| NPI | 1194455477 |
|---|---|
| Doing Business As | GAUDENZIA GLEN BURNIE |
| Entity Type | Organization |
| Authorized Contact | MIKE WILLIAMS Sr. Contract Manager 484-338-3731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2022-09-26 |