| NPI | 1861841595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLA MICHELLE MAESTAS Registered Agent 307-371-2331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-12 |