| NPI | 1790816387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS EDWARD DEGRAVE Chief Operating Officer 716-675-1928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 173319) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |