| NPI | 1912362716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET VODVARKA Sole Practitioner 508-358-9688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MA 2613) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2015-12-21 |