| NPI | 1780607085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA L SOULE Office Manager 518-324-3074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 228208) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-08-03 |