| NPI | 1396775201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GALLOWAY ROTH President 410-455-9660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: MD A1357) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MD A1357) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2018-08-17 |