| NPI | 1619395605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBYN TANIS Executive Director Practice Mgmt 856-533-8762 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone (Licence: KY 810381) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2019-12-20 |