| NPI | 1346419769 |
|---|---|
| Doing Business As | STATELINE MEDICAL |
| Entity Type | Organization |
| Authorized Contact | ROBYN TANIS Executive Director Of Contract Mgmt 856-533-8762 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2022-04-26 |