NPI | 1013001957 |
---|---|
Entity Type | Organization |
Authorized Contact | RAY A CHANEY Clinic Administrator 860-701-6736 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient |
Enumeration Date | 2006-10-03 |
Last Update Date | 2020-08-22 |