| NPI | 1689128266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN S SANDERSON President 717-580-4189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL CH11618) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2017-03-09 |