| NPI | 1932105996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BALKO Physician Owner 866-758-4862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 34-00-4454D) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE6726-T) |
| 213E00000X Podiatrist (Licence: PA 36-00-3012-I) | |
| 231H00000X Audiologist (Licence: PA AT-001085-L) | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2013-01-31 |