| NPI | 1255797726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARISSA BEAULIEU Administrator 860-242-2193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CT 0350) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2020-12-21 |