| NPI | 1326292590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN PATRICIA BELANGER Administrator 860-583-1526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CT 002) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2008-11-13 |