| NPI | 1184010118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS GROBLEWSKI Statewide Medical Director 781-706-1052 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MA RN2269378) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2015-04-07 |