| NPI | 1134450828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD DALE AGNES President/Physician 860-978-8825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: CT 036511) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 036511) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2013-06-19 |