| NPI | 1326632936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCILLE FORMEISTER Director, Business Systems 860-667-9542 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2021-06-15 |