| NPI | 1114388808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVERY ANISE WATSON Owner 860-888-6058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC p009306) |
| Additional Taxonomies | 251S00000X (Licence: NC 20099) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |