| NPI | 1205941879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY L DETZER Bus Manager 802-296-7370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VT 0420008456) |
| Additional Taxonomies | 208800000X Urology (Licence: NH 8746) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-17 |