| NPI | 1790800480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLENE MARIE HAVILAND President Owner 860-741-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 001494) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |