| NPI | 1730636812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY JO WOOD NEESON Owner 307-751-0645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WY 19472.0369) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2018-03-12 |