| NPI | 1619217502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE ANN WILSON Managing Member/Owner 508-369-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: RI NPP37242) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: RI RN40329) |
| Enumeration Date | 2013-02-28 |
| Last Update Date | 2013-02-28 |