| NPI | 1649630427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN NOVAK Registered Nurse 802-324-9194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: VT 026.0028569) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-03-07 |