| NPI | 1881804508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES WALLACE Administrator 203-231-5595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CT 0268) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2023-01-18 |