| NPI | 1851779961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE BURKHOLDER Owner 307-690-7814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CA 1977) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-05-08 |