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| Type | Address | [sources] | |||
|---|---|---|---|---|---|
| Country | United States | [sources] | |||
| City | Out-of-State NY · Out-of-State NY · Out of State (NY) | [sources] | |||
| Full address | Out of State (NY), PA · Out-of-State NY, PA | [sources] | |||
| State | PA | [sources] | |||
| Street address | not available | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers who are precluded from participation in the Medical Assistance Program
United States · DHS
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