| NPI | 1780968743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER EDIS Executive Director 307-688-5022 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2011-10-08 |