| NPI | 1811285059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH ROBITAILLE Program Director 307-234-6161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WY 390200000X) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2011-07-20 |