| NPI | 1649705674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN LEA JOHNSON Practice Manager 724-720-9320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: PA PC008344) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-04-27 |