| NPI | 1790181873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNADINE O LEWIS President And CEO 267-975-9313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: PA MA050628) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2014-11-17 |