| NPI | 1033530696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PETRY Director Of Practice Administration 802-430-7254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2018-07-24 |