| NPI | 1053785170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE DESROCHES Chief Administrative Officer 866-305-7365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: FL MH1352) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2015-12-01 |