| NPI | 1992527683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHEYLOH BLUEMEL Manager 307-461-0845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2024-10-24 |