| NPI | 1235597741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABITHA B FORTT Member/Manager 203-674-0774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CT 037894) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2016-02-02 |