| NPI | 1639425903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK LOGAN Medical Director 802-775-7798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: VT 47D2042960) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2012-07-24 |