| NPI | 1336678374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHEL GOUBRAN President 570-507-9517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: PA MD035965L) |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty (Licence: PA MD035965L) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2022-07-21 |