| NPI | 1497051395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD LEE BROADWATER Owner/Medical Provider 443-281-8086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MD D15200) |
| Enumeration Date | 2011-02-10 |
| Last Update Date | 2014-03-06 |