| NPI | 1629659578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELONDA WILSON COO 860-690-5309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2023-11-06 |