| NPI | 1902818826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LU FERNANDEZ Supervisor 617-847-1926 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MA 1025460) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-22 |