| NPI | 1144755455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL R. STOYAK Owner 802-448-3759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: VT 042.0013430) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2017-04-24 |