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4510 Church Rd Mount Laurel NJ 08054-2210 | |
| (856) 439-0060 | |
| (856) 439-0061 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 4510 Church Rd, Mount Laurel, New Jersey |
| Authorized Official Name and Position | Thomas Y Lee (OWNER) |
| Authorized Official Contact | 8564390060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4510 Church Rd Mount Laurel NJ 08054-2210 Ph: (856) 439-0060 | 4510 Church Rd Mount Laurel NJ 08054-2210 Ph: (856) 439-0060 |
| NPI Number | 1730186784 |
|---|---|
| Provider Enumeration Date | 07/06/2005 |
| Last Update Date | 05/10/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730186784 | NPI | - | NPPES |
| DH0748 | Other | RAILROAD MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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