| NPI | 1235296393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES KIPP HEACOCK Owner 732-458-7777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NJ MA 34928) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2020-08-22 |