NPI | 1417051780 |
---|---|
Entity Type | Organization |
Authorized Contact | LU FERNANDEZ Supervisor 617-847-1926 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MA 1025460) |
Enumeration Date | 2006-09-08 |
Last Update Date | 2020-08-22 |