| NPI | 1942322813 |
|---|---|
| Doing Business As | STATELINE MEDICAL |
| Entity Type | Organization |
| Authorized Contact | GARY DAVID GAVORNIK Executive Director 908-387-0003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone (Licence: NJ 22481) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-08-22 |