| NPI | 1588681373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS MINEAU Administrator 860-667-1815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CT 0272) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2015-05-18 |