| NPI | 1023433604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN CARLOS CORNEJO Medical Director 856-552-2208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB08477000) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2014-02-19 |