| NPI | 1194600197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY RALSTON Chief Operating Officer 570-445-7231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2025-08-08 |
| Last Update Date | 2025-08-08 |