| NPI | 1710619515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOLANDA HAYES Owner 443-539-3001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-07-25 |