| NPI | 1972788321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BAIN PATRIE Credentialing Specialist 860-347-6971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2012-11-02 |