| NPI | 1831488766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE ROSEN Administrator 215-988-9503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: PA OS004236L) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2011-03-31 |