| NPI | 1528770435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY RENNA THOMAS Billing Manager 410-616-9552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2022-12-22 |
| Last Update Date | 2022-12-22 |