| NPI | 1801271861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI LYNN COLLINS Owner/Operator 302-229-8239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: DE MT-0002666) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2015-07-20 |