| NPI | 1336202704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CARTER Administrator 307-672-7874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WY 07-012) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2008-03-27 |