| NPI | 1093447021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ENEDINA VASCO Employee, Owner 307-463-0541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2023-08-30 |