| NPI | 1669604930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY WALLACE Director Of Operations 410-933-3013 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2009-08-19 |