| NPI | 1831347095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROCHELLE DAWN STARK M.D. / Owner 307-460-2055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 1040 (temporary)) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2008-08-29 |