| NPI | 1023550977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA J TUCKER Owner 215-301-1193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: PA sp011218) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-11-09 |