| NPI | 1639527906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD STUCKEY CFO 443-539-2356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: VA 0133000736) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2016-05-27 |