| NPI | 1104644418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM KELLY Medical Director 570-709-3599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2024-09-26 |