| NPI | 1417418724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOWANNA FONTENOT Medical Director/Physician 443-699-0321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QI0500X Clinic/Center Infusion Therapy |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2019-05-13 |