| NPI | 1376865816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP J STATES Owner/Proprietor 814-938-3550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: PA 393918) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2011-12-20 |