| NPI | 1629352406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMN M SNYDER Administrative Assistant I. 307-548-6543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2011-09-28 |