| NPI | 1962690461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY TREY President 617-632-9252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MA 57207) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2010-04-28 |