| NPI | 1598717969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH HOLDREN CAO 570-271-5490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2008-06-27 |