| NPI | 1689187072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN ROMAN Owner 570-213-5221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2019-07-15 |