| NPI | 1780922732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA C MARRA Nurse Case Coordinator 888-853-6412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: DE l10030304) |
| Enumeration Date | 2013-01-26 |
| Last Update Date | 2013-01-26 |