| NPI | 1922275270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL A MONTGOMERY Provider 315-472-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY 161110789) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2017-02-01 |