| NPI | 1407617871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGRID T LONG CEO 307-532-2107 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2024-08-30 |