| NPI | 1629121330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA EICKHOFF Executive Director 307-232-0124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| 208D00000X General Practice | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2016-09-17 |