| NPI | 1811569288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY R THOMAS Credentialing Specialist 410-663-4036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |