| NPI | 1346441987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VESTA KIM Owner 732-257-3755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NJ TD3443) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-08-22 |