| NPI | 1245779685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA CISNEROS Sole Proprietor 443-741-2294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MD LC4473) |
| Additional Taxonomies | 251S00000X (Licence: VA 701006308) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-02-17 |