| NPI | 1922764604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA BARNES CEO 307-287-1555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2021-12-27 |