| NPI | 1588107668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRINA JOUKOVA President 267-307-9236 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: PA MD 435017) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: PA MD 435017) |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2016-11-22 |