| NPI | 1821440009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE M. ABRAHAM LEWIS President 443-449-9991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MD LPG7130) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: MD LGP7130) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2016-07-12 |