| NPI | 1881884641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETSY GRAVES Office Manager 860-645-6675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 021430) |
| Additional Taxonomies | 235500000X Specialist/Technologist (Licence: CT 000196) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2015-12-29 |