CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC

WILKES BARRE, PA
NPI1184177263
Entity TypeOrganization
Authorized ContactMATTHEW PHILIP SMOLAREK
CFO
412-999-5188
Organization Subpart ?No
Primary Taxonomy261QM1300X Clinic/Center Multi-Specialty
Additional Taxonomies207RA0401X Internal Medicine Addiction Medicine
Enumeration Date2016-07-26
Last Update Date2024-07-03
Business Address
CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC
100 N WILKES BARRE BLVD STE 103
WILKES BARRE, PA 18702-5240
Phone number: 413-584-2173
Mailing Address
CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC
8 CADILLAC DR STE 180
BRENTWOOD, TN 37027-5393
Phone number: 615-425-0220