| NPI | 1770763617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY C BLAKE Owner & Operator 315-457-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 223034-1) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2007-11-08 |