| NPI | 1801088497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EARLENE HASTINGS Executive Director 307-682-2392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WY 100162100) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2007-08-17 |