| NPI | 1063646552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY J DISTEFANO Owner 508-852-6028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MA 21567) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2009-05-12 |