| NPI | 1396801908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN L. FAUBION Officer 307-856-6612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WY 645) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2008-02-21 |