| NPI | 1285112052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN VALANZOLA Provider Enrollment Supervisor 781-681-0384 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2024-01-23 |