| NPI | 1518204619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY D'AGOSTINO Pa 239-262-6111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME0066399) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: FL 10D0944089) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2013-01-14 |