I assume that your remote do not have private Point-to-point back to Main Site. So bascially, you have T1 internet, cable or DSL at remote site.
My suggestion is:
1. Have POTS (order from carrier, e.g. verizon) at remote site for 911 call.
2. I personally prefer H.323 over MGCP.
3. you need PVDM2, VIC2-2FXO(there are 2 port, 4 ports option that you can pick)
4. Inline power switch (external or internal (Etherswitch at router)).
5. IP Phones for all users.
6. Yes, you need configure IPSEC Tunnel (VPN) between router and PIX.
http://www.cisco.com/en/US/products/hw/vpndevc/ps2030/products_configuration_example09186a0080094498.shtml
Please rate this post if it helps.
Ken