| NPI | 1851392187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE STROUP Billing Credentialing Administrator 570-501-6863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD044497L) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2008-05-01 |