| NPI | 1205374535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY A SMITH Registered Dietitian 267-872-1093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: PA DN005325) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |