| NPI | 1427301969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE MATTIS Chief Financial Officer 307-347-6185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2012-10-22 |