| NPI | 1194247155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE TRAPPER Sr. Clerk Typist 716-858-8917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2400X Clinic/Center, Prison Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2017-07-12 |