| NPI | 1215464003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL GILL Physician 410-544-8433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MD 01032) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |