| NPI | 1982158374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHIE HERNANDEZ Manager 781-284-4001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MA 692) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-08-15 |