| NPI | 1962420935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE BACKER Practice Administrator 215-855-1054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD014269E) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-02-27 |