| NPI | 1740767805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD WILLIAMS BAKER Owner 315-529-8821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2024-09-13 |