| NPI | 1316021355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BASILE Director 410-706-7936 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: MD 182) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 4626) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2017-02-06 |