| NPI | 1619490752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN MATTA Owner 267-314-7555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS014889) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2021-02-13 |