| NPI | 1861525263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYBETH MARTIN Manager, Clinical Assistant 814-877-5564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD025800E) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |