| NPI | 1902494024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANE E HYSKELL Credentialing Agent 814-938-8263 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-01-05 |