| NPI | 1912290123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM HESCHKE Office 716-434-2874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 003342) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2011-05-20 |