| NPI | 1194481721 |
|---|---|
| Former Legal Business Name | PREMIUM HEALTHCARE CENTER |
| Entity Type | Organization |
| Authorized Contact | IKENNA D USONWU Director 732-910-8673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2021-11-09 |