| NPI | 1932159142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY LYNN LADD Practice Administrator 802-388-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2020-10-14 |