| NPI | 1164993291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN GERVAIS Practice Manager 508-556-1072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2024-11-19 |