| NPI | 1942261573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ROBERTSON Administrator 307-472-8781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WY 08 012) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2008-05-13 |