| NPI | 1598046567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIN NOWACKI Lcc 410-430-4267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MD 163W00000X) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2011-09-06 |