| NPI | 1457737967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOLAMARIE DAVIS Administrator 215-239-3096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA OS011923) |
| Additional Taxonomies | 111NR0400X (Licence: PA DC002363) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-08-06 |