| NPI | 1962714154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN BAILEY Officer/Authorized Official 203-609-1168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2024-09-17 |