| NPI | 1902213093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUNNY GOGGLES Director 307-856-0470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-07-21 |