| NPI | 1366700759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMI GEROSKI VP Corporate Compliance 570-344-9237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2012-04-24 |