| NPI | 1629322037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL SHERO Executive Director 307-864-2146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WY 1450) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2012-11-07 |