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 |