| NPI | 1801894522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA HUCKINS Administrator 307-686-8283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WY 06015) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2020-05-11 |