Organization
US NAVY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ISMAEL ARTURO LOPEZ SUB IDC (SUB IDC)
(361) 522-5925
Entity
Organization
Contact information
Practice address
207 HICKORY DR, GROTON, CT 06340-2946
(361) 522-5925
Mailing address
207 HICKORY DR, GROTON, CT 06340-2946
(361) 522-5925
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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