| NPI | 1528719499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE WILSON Owner 215-303-1761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251E00000X Home Health |
| 305S00000X Point of Service | |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-03-08 |