| NPI | 1740723212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETA STEPHEN TATAW Primary Care Provider 240-386-9682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MD R178223) |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2016-11-30 |