Organization
IYI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLY KASONGO M.D., R.V.S. (C.E.O.)
(215) 971-7389
Entity
Organization
Contact information
Practice address
6425 TULIP ST, PHILADELPHIA, PA 19135-3324
(215) 971-7389
Mailing address
6425 TULIP ST, PHILADELPHIA, PA 19135-3324
(215) 971-7389
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
293D00000X
Physiological Laboratory
—
—
Other
Enumeration date
05/25/2008
Last updated
05/25/2008
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