| NPI | 1780076364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW WILEY Clinic Supervisor 307-789-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WY 33582.1375) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2015-02-19 |