| NPI | 1215028055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORLISS ADAM VARNUM President 315-343-6974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2019-03-15 |