| NPI | 1114408739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT J. ROSS President 307-632-7677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: WY 3871A) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2018-08-22 |