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BALTIMORE, MD
NPI1952834004
Entity TypeOrganization
Authorized ContactASHLEY NICOLE ROCK
Program Director
410-340-8824
Organization Subpart ?No
Primary Taxonomy251S00000X 
(Licence: MD  MH-2293)
Enumeration Date2017-04-05
Last Update Date2022-10-12
Business Address
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638 N GILMOR ST
BALTIMORE, MD 21217-2101
Phone number: 410-340-8824
Mailing Address
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638 N GILMOR ST
BALTIMORE, MD 21217-2101
Phone number: 410-340-8824