| NPI | 1306221106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY GLENN Owner 814-758-8425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: GA POD001277) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2022-01-03 |