| NPI | 1104003235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDITH GWENDOLINE GRANNUM Medical Director 585-233-1366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 210929) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-03-19 |