| NPI | 1942652391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT STACHURA Athletic Trainer 860-316-8870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: RI 2255A2300X) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-07-11 |