| NPI | 1013362771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACEY BRANDON Director 203-695-4917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CT 2384) |
| Additional Taxonomies | 251S00000X (Licence: CT 1113) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2016-08-31 |