| NPI | 1740307099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIVONNE NIKELL PRIOLEAU-GREEN Health Service Technician 215-271-4816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |