| NPI | 1548402613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ORVILLE DAVE PALMER Owner 917-501-6193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NY 208819) |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2009-04-03 |