| NPI | 1992143648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA SUE MOSHER Fnp 307-259-2434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: WY 9206-1081) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2013-06-04 |