| NPI | 1366878977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN P WALLA Nurse Practitioner 307-685-8255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: WY 29650.1122) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2014-10-24 |