| NPI | 1023389533 |
|---|---|
| Former Legal Business Name | KOINONIA PRIMARY MEDICAL CARE PC |
| Entity Type | Organization |
| Authorized Contact | ROBERT JOHN PAEGLOW President 518-689-0282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2012-01-16 |
| Last Update Date | 2012-01-16 |