| NPI | 1003107954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD JOHN TESORIERO Owner/Provider 315-343-5713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NY X002605-1) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-09-15 |