Organization
LOURDES MEDICAL ASSOCIATES PA
Active
Parent organization
MEDVANTX, INC
Other names
LMA Willingboro Town Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
200 CAMPBELL DR, SUITE 102, WILLINGBORO, NJ 08046-1067
(609) 877-4545
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA04258100
NJ
Other
Enumeration date
06/05/2013
Last updated
06/05/2015
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