| NPI | 1265920615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMALA BUTLER Credentialing Specialist 301-883-7822 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Additional Taxonomies | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2020-09-17 |