| NPI | 1376868174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD O CROSLEY Director 410-732-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MD D0016109) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: MD D0016109) | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2010-04-05 |