| NPI | 1033704630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELL L. CLARK Owner 215-205-2294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2021-05-13 |