| NPI | 1588853162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN H THEDIECK Owner 307-745-4884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WY 6716A) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2007-10-18 |