| NPI | 1992073191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW MAJKA CFO 802-885-7629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2011-12-02 |