| NPI | 1700194420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEECE GUTIERREZ Owner 307-237-0656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WY 2010-000588996) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2010-09-15 |