| NPI | 1467583286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH SOSA Credentialing And Enrollment Manage 508-213-1947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2021-11-10 |