| NPI | 1275577405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM G WICKHAM Practice Administrator 814-838-3480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD043940L) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-08-22 |