| NPI | 1871366336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SABRINA GIBSON CFO 307-277-1006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |