| NPI | 1740548346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEWITT CHARLES FORTENBERRY Medical Director 301-641-5512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX L8691) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2023-09-17 |