| NPI | 1902077266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD FRANCIS CONGDON Managing Physician 888-467-1117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2019-03-06 |