| NPI | 1174254262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAX HOUSEKNECHT CFO 570-567-5418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2024-09-24 |