| NPI | 1326719733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ILYAGU Owner 717-716-7107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2024-05-20 |