| NPI | 1902459407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW T ROGERS President 570-271-6781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2020-01-27 |