| NPI | 1609190164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN ERIC FENTON Physician 802-859-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VT 032-0000356) |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2010-07-30 |