| NPI | 1902382252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARNISHA FITZGERALD Sole Proprietor 443-763-7154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2024-05-16 |