| NPI | 1528416740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TERRY SULLIVAN Medical Director 410-336-0194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MD D45426) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2016-05-27 |