| NPI | 1053735886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY D AMIDON Managing Member 315-507-5081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 192498) |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2019-03-01 |