| NPI | 1548524853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YANANTS ANTONEVICH Owner/President 617-202-9222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2014-02-27 |