| NPI | 1407004534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD J BROUILLETTE Regional Medical Director 410-290-9191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2023-04-24 |