NPI | 1811929300 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHN FRESE Medical Director 860-442-0290 |
Organization Subpart ? | No |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CT 0303) |
Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical |
Enumeration Date | 2006-07-07 |
Last Update Date | 2009-05-07 |