| NPI | 1477672632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOSSRI MAHIR KAIRLIS Owner 802-251-1031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VT 0160002043) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2012-12-12 |