| NPI | 1306971577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKSON P MAILLE Medical Director 203-679-0055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 036274) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |