| NPI | 1497915359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE JON FOREST Medical Director 203-378-9002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CT 039202) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2009-01-15 |