| NPI | 1881700755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH HOLDREN CAO 570-271-5490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2008-06-30 |