| NPI | 1316962244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE MOORE Administrator 410-828-4789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: MD A1413) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-22 |