| NPI | 1871789628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY J GANDY Billing Manager 856-451-9395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA03258300) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2010-04-06 |