| NPI | 1679560403 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORETTA KOWALICK Practice Administrator 610-402-1757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2022-07-21 |