| NPI | 1477098663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMALIA FANTASIA Adminstor 856-489-0555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25mb05610900) |
| Enumeration Date | 2016-12-27 |
| Last Update Date | 2016-12-27 |