| NPI | 1679701312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE GAYLE BURKHOLDER Owner 307-690-7814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WY 1085) |
| Additional Taxonomies | 251S00000X (Licence: TN 1534) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2009-07-01 |