| NPI | 1235543505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES KIPP HEACOCK Owner 732-814-9807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NJ 25MA03492800) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2014-06-16 |