| NPI | 1871862599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L MOORE Regulatory License Manager 207-356-4244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2011-12-27 |
| Last Update Date | 2023-10-04 |