| NPI | 1386980191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAMIL MANSOUROV Medical Director 203-847-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 040028) |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2016-01-18 |