| NPI | 1184178121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD M WERNER Owner 518-310-3644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 096889) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-12-01 |