| NPI | 1902127095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRAKORB ISARIYAWONGSE Owner 724-785-9696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: PA 033993L) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: PA 033993L) |
| Enumeration Date | 2010-06-13 |
| Last Update Date | 2010-06-13 |