| NPI | 1417357534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT DAVID THOMAS Owner 307-690-8713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: ID M-7462) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2017-01-23 |