| NPI | 1366738734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA SHARLENE WILSON Owner 410-227-7191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: DC PRC14103) |
| Additional Taxonomies | 251S00000X (Licence: DC LMFT000138) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2011-06-23 |