| NPI | 1609128164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RUSSELL JOHANSSON Osteopathic Physician 802-878-9700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QX0100X Clinic/Center, Occupational Medicine (Licence: VT 032.0000304) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2012-10-09 |