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 |