| NPI | 1942533039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGEL C. JAQUEZ Director 860-218-1725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2012-12-18 |