| NPI | 1760650980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ALAN RICHARDSON Owner/Medical Director 307-382-8668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WY 4012A) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2008-04-03 |