| NPI | 1902941917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA LYNN WINGATE Sole Proprietor 802-442-0158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420010148) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |