| NPI | 1952658056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN M LUISI Manager 617-913-3321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MA DH11340) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-07 |