| NPI | 1568772242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE L HEADLEY Proprietor/Physician 860-536-1354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 034245) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-11-09 |