| NPI | 1831508829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI MCCALLUM Nurse Practitioner 443-600-0105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MD R177915) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: MD R177915) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2015-01-07 |