| NPI | 1558857474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMALA BUTLER Credentialing Specialist 301-883-7822 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2020-09-17 |