| NPI | 1043495831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD KEVIN HARRIS Psc/Ma, Mfti 570-482-2244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CA IMF 53142) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2010-06-10 |