| NPI | 1336144617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER JENSEN Medical Director 307-382-6873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WY 05-124) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2007-11-02 |