| NPI | 1255674032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN AKTON BENWELL Operations Manager 410-375-9072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL 10D2054584) |
| Enumeration Date | 2013-03-31 |
| Last Update Date | 2013-03-31 |