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 |