| NPI | 1780613521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS WISCH Medical Director 860-482-4866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: CT 0285) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2007-12-28 |