| NPI | 1922133677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CARLYLE ELDRED Owner 307-638-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: WY 250T) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: WY 103T) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2011-08-10 |