| NPI | 1952697526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JES CORNBOWER Supervisor 717-646-4245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA MA054900) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-06-22 |