| NPI | 1447630157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARA GIBBS Owner 716-720-5837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NY TUV006826) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2015-06-08 |