| NPI | 1407095771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATINA LAWDIS Owner 508-877-5525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MA 3863) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2009-02-11 |