| NPI | 1629094917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY HEACOCK Medical Director 410-841-5279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MD A1360) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-12-03 |