| NPI | 1659960235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY CLAUDIUS OGLESBY Member 856-655-8910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| 251V00000X Voluntary or Charitable | |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2021-01-18 |