| NPI | 1184128563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD DUVALL CEO 315-519-5207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: NY 2238700C) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2021-02-18 |