| NPI | 1568615441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK E LOGAN Provider 802-775-7848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: VT 0420006819) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2010-06-18 |