| NPI | 1558656124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOB SULIMANOV Manager 610-277-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: PA 00389no07133833) |
| Enumeration Date | 2011-06-12 |
| Last Update Date | 2011-07-26 |