| NPI | 1780806240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J. GRAVELEY Owner 610-444-5406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2008-04-14 |