| NPI | 1891148219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN BEASLEY Officer/Authorized Official 203-609-1168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2024-10-28 |