| NPI | 1982815445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD DUVALL CEO 315-519-5201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: NY 2238001H) |
| 261QP2300X Clinic/Center Primary Care (Licence: NY 2238001H) | |
| 261QS1000X Clinic/Center Student Health (Licence: NY 2238001H) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2021-05-05 |