| NPI | 1538128350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMA DEWITT Ubo Manager 860-694-4879 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2025-06-13 |