| NPI | 1760760250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA RAE COBURN Chief Office Administrator 716-307-5969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AZ AP4081) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2011-08-01 |