| NPI | 1750742367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY FASOLINO Executive Director 716-810-1828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |