| NPI | 1952646135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAE O'BRIEN Executive Director 215-364-4247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: PA MD073793L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS022264L) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2012-11-29 |