| NPI | 1629715602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ELIZABETH DAVIS Fnp/Owner 307-214-4537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2022-11-13 |