| NPI | 1518562842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALISTA CHANA CEO 410-878-1084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-12-03 |
| Last Update Date | 2023-01-27 |