| NPI | 1922479369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVIA SHEA LOCKER Proprietor / Owner 860-481-2950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 53961) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2026-05-08 |