| NPI | 1346700093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM KENNEDY Administrative Services Manager 860-697-3364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2019-05-15 |