| NPI | 1255512638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI FIELDS Credentialing 443-567-6120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2025-08-20 |