| NPI | 1568833515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA STABLEY Office Manager 570-327-1414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: PA PS005718L) |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2015-10-16 |