| NPI | 1871941070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDI SORESSI Program Administrator 617-789-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MA 256860) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2016-05-27 |