| NPI | 1831670744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD WILLIS Owner 307-214-5129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 6779A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WY 6779A) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2018-08-28 |