| NPI | 1205957982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WYATT HELLEY Health Service Technican 3 Class 508-968-6704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |