| NPI | 1013135284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL FULLER Owner 570-714-5880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: PA TP000953B) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2009-12-17 |