Organization
302 BODY SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONNIE DIEM PA-C (OWNER)
(302) 331-9026
Entity
Organization
Contact information
Practice address
4601 SOUTH DUPONT HIGHWAY, ST 1, DOVER, DE 19901
(302) 698-1100
Mailing address
4601 SOUTH DUPONT HIGHWAY, ST 1, DOVER, DE 19901
(302) 331-9026
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/05/2023
Last updated
09/05/2023
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