NPI | 1912478819 |
---|---|
Entity Type | Organization |
Authorized Contact | KRISTINE VAN KIRK Owner/Provider 307-823-2968 |
Organization Subpart ? | No |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
Additional Taxonomies | 2083B0002X Preventive Medicine, Obesity Medicine |
Enumeration Date | 2018-12-17 |
Last Update Date | 2018-12-20 |