| NPI | 1306133475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZBETH KAY ESTES Office Manager 508-295-4902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MA 57120) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 57120) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2023-12-08 |