| NPI | 1255512638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI MITCHELL Credentialing 410-542-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2011-05-25 |