| NPI | 1538350616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELODIE KRAHULA Team Leader 518-626-5130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: NY 73-071874) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2007-08-05 |