| NPI | 1447767934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOLYMAR HERRERA Credentialing Coordinator 203-777-7411 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CT 0901) |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2018-01-05 |