| NPI | 1154834927 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL LEWIS GOMBOSI Owner 570-244-1877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: PA MD043621L) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2017-11-14 |