| NPI | 1205117611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE BENNETT Sole Member 307-439-9088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 7871A) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2013-01-13 |