| NPI | 1942812144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVONDA L KEATING Sr Production Unit Mgr 410-933-6430 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2021-03-07 |