NPI | 1811315757 |
---|---|
Entity Type | Organization |
Authorized Contact | ANNA CECILIA BRACAMONTE Clinician I 860-951-8770 |
Organization Subpart ? | Yes |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CT 1841301876) |
Enumeration Date | 2014-03-28 |
Last Update Date | 2014-03-28 |