| NPI | 1104590264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN ASHLEY DAVIS Co Owner / Member 856-332-1151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2021-08-03 |