| NPI | 1104153386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JEAN SPRING Director Office Operations 860-274-1773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2018-09-12 |