| NPI | 1902180532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON VASHON MACK President 307-362-1444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WY 7706A) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2011-09-30 |