| NPI | 1225552177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | D. TINA SMITH Provider Enrollment Spec. 215-925-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2017-09-06 |