| NPI | 1891113221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN BLACK Billing Specialist 410-871-1478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-12-22 |