| NPI | 1790046647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA ZIPPORA WREN Ad MIS Trative Assistant 240-640-0523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |