| NPI | 1104899756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE M JOHNSTON Co Owner 315-292-1264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 180710) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2018-12-18 |