| NPI | 1114195815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILFREDO TOMAS CORREA CRUZ Owner 973-632-4579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NJ 25MA07690500) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-02-15 |