| NPI | 1740605088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIA FLETCHER BOLEY Registered Dietitian 307-752-8213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: WY 81) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-09-11 |