| NPI | 1063824381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBYN TANIS Executive Director Of Contract Mgmt 856-533-8762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: KY 810355) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2021-09-09 |