| NPI | 1679168215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI MUIR Administrator 774-454-2893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2021-07-13 |