| NPI | 1144731738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY CONNOLLY CFO 518-591-4461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: NY 0101205R) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2017-10-23 |