| NPI | 1528142809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD A JACKSON Supervisor 508-968-6713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1101X Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |