| NPI | 1144709809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY SUSAN BOCK Billing Manager 570-424-2929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2018-08-13 |