| NPI | 1134890650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA NEWMAN Operations Manager 307-789-4224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2023-03-13 |