| NPI | 1164824389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSEY VESTAL Owner 917-601-1299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: NY 016848) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-11-12 |