| 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 |