| NPI | 1255877635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW RAYMOND PROVOST Registered Nurse 413-885-0840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CO 1640198) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-01-10 |