| NPI | 1205080348 |
|---|---|
| Other Name | PINE STREET INN - MEN'S CLINIC |
| Entity Type | Organization |
| Authorized Contact | AGNES W LEUNG Chief Financial Officer 857-654-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MA 4LQX) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2018-05-24 |