| NPI | 1639560113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANASTASIA JB GREER Credentialing Coordinator 802-448-9719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2015-02-05 |