| NPI | 1669924783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA BLACK Regional Clinical Director 617-600-3195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |