| NPI | 1265692453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY JEAN ROSEBERRY Owner 802-779-0114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0011545) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2009-10-09 |