| NPI | 1346655164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAH VOLK Sole Provider 307-277-2753 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WY 2014-000665851) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2014-07-01 |