| NPI | 1467725978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERTHA MAYORQUIN Owner/President 551-697-3696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08638600) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |