| NPI | 1730765744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARA-JEAN DONAGHEY Manager 603-417-4378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-03-20 |
| Last Update Date | 2021-07-14 |