| NPI | 1639793912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY WALSH Director Of Operations 570-622-5455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2020-06-03 |