| NPI | 1639621709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YADITSY CANTERO Credentialing Specialist 585-423-2853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: NY 194379) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |