| NPI | 1972889764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MELVIN SMALL Office Manager 307-674-1668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: WY ML-2011-017) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |