| NPI | 1265683726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD W HENLINE Physician 315-265-6494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 204678) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2012-05-08 |