NPI | 1760402192 |
---|---|
Entity Type | Organization |
Authorized Contact | KENNETH HOLDREN CAO 570-271-5490 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 363A00000X Physician Assistant |
363L00000X Nurse Practitioner | |
Enumeration Date | 2006-07-20 |
Last Update Date | 2008-06-30 |