| NPI | 1831580240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY B KING Owner 307-721-2880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2015-02-07 |
| Last Update Date | 2021-01-22 |