| NPI | 1942253695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARJORIE NICKELS Billing Secretary 315-453-7289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 139251-1) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-12-24 |