| NPI | 1558503342 |
|---|---|
| Doing Business As | VENDOR |
| Entity Type | Organization |
| Authorized Contact | VIDADE M RATEAU Mha 857-753-9760 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2009-03-25 |