| NPI | 1811289218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK LLOYD WISNIEWSKI Co Owner 307-670-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WY 10312) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2011-05-04 |